REGISTRATION FORM - Malaysian Delegate
DELEGATE DETAILS
Full Name:
*
Name on Badge (Limited to 15 characters):
*
Designation / Position:
*
Place of Practice/ Work/ Study :
*
Address :
*
City :
*
State :
*
Country :
*
Postal Code :
*
Email :
*
Fax :
Tel. (Office) :
*
Mobile:
Are you participating in any oral/ poster presentations?
Yes
No
Special diet preference
No
- Gluten-free
Yes
- Vegetarian
Yes
- Vegan
Yes
REGISTRATION FEES (Please Tick the Appropriate box)
Category:
Early bird Registration:
1st December, 2016 to 31st May 2017
Late bird Registration:
1st June to 1st July, 2017
Malaysian delegates:
RM 1300
RM 1400
PRECONFERENCE WORKSHOPS (Please Tick the Appropriate boxes)
No.:
Workshop:
Fee
0.
Not interested
RM 0
1.
Mindfulness Based Cognitive Therapy and Cognitive Flexibility
- Dr. Bergljot Gjelsvik (GBR)
RM 300
2.
Suicide in Older Adults
- Emeritus Prof Diego De Leo (AUS), Prof Sylvie Lapierre (CAN), A. Prof Annette Erlangsen (DNK), Dr Reinhard Lindner (DEU)
RM 300
3.
Cognitive Behavioral Therapy for suicidal persons
- Prof Ad JFM Kerkhof (NLD)
RM 300
4.
Psychological autopsy
- Dr. Lanny Berman (USA)
RM 300
5.
Gatekeeper training: The bridge between suicide and life
- Kevin Briggs (USA)
RM 300
6.
The solution focused approach to suicide prevention
- John Henden (GBR)
RM 300
7.
Supervision in psychodynamic psychotherapy
- Prof. Dr. Cesar A Alfonso (USA)
RM 300
Please choose payment method:
(Please note: ALL FEES ARE INCLUSIVE OF 6% GOODS AND SERVICES TAX (GST))
Payment by Paypal / Credit Card
Payment by Local Purchase Order / Cheque / Bank Draft / Telegraphic Transfer